Subjective
Date of visit
Reason for visit (prenatal diagnosis, suspected placenta accreta, post-partum hemorrhage)
History of present illness:
Prenatal ultrasound findings suggestive of placenta accreta spectrum (increased placental adherence, prior uterine surgery)
Antepartum bleeding (if present)
Past medical history (relevant conditions, prior cesarean deliveries, uterine surgeries like myomectomy)
Gravidity and parity (number of pregnancies and deliveries)
Medications (current medications)
Allergies
Objective
Vital signs (temperature, heart rate, blood pressure)
Physical exam (if applicable):
Abdominal examination (fetal size and lie, uterine tone)
Pelvic examination (cervical dilation, effacement)
Assessment
Placenta accreta spectrum (suspected or confirmed based on prenatal ultrasound, prior uterine surgery history, or post-partum hemorrhage)
Specific type of placenta accreta (accreta, increta, percreta) – may be determined prenatally or during surgery
Gestational age (fetal viability)
Planned delivery approach (depending on severity, location of placenta, and fetal viability)
Consider risks and benefits of expectant management (for previa and viable fetus) vs. immediate delivery
Blood bank status (availability of blood products for potential hemorrhage)
Plan
Depending on the presentation and severity:
Prenatal monitoring:
Serial ultrasounds to assess placental location and invasion
Amniocentesis (may be considered to assess fetal lung maturity)
Feto-maternal medicine consultation for high-risk pregnancy management
Delivery planning:
Multidisciplinary team approach (obstetrician, anesthesiologist, neonatologist, blood bank)
Delivery at a facility equipped for managing major hemorrhage
Planned cesarean delivery with potential for hysterectomy (removal of the uterus)
Blood product availability (packed red blood cells, fresh frozen plasma)
Postpartum management:
Close monitoring of vital signs, blood loss
Uterine atony management (medications to promote uterine contraction)
Potential for interventional radiology or surgical procedures to control bleeding
Consideration of future fertility:
Discuss potential impact of hysterectomy on future childbearing
Education
Explain the diagnosis of placenta accreta spectrum and potential complications (hemorrhage, need for hysterectomy)
Discuss the planned delivery approach and potential risks and benefits.
Importance of adherence to follow-up appointments and monitoring.
Support resources for high-risk pregnancies (if applicable)
Follow-up
Schedule for follow-up appointments:
Prenatal monitoring (ultrasound) for suspected placenta accreta
Delivery planning and hospitalization for confirmed cases
Postpartum monitoring for hemorrhage and recovery
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and management of placenta accreta spectrum.